Player/Volunteer Personal Details

Personal Information

Your Forename

Your Surname

Your email address

Your Telephone Number

Your Date of Birth

Your Address

Your Postcode

Parent/Carer/Next of Kin's Name

Parent/Carer/Next of Kin's Email

Parent/Carer/Next of Kin's Telephone Number

Emergency Contact Telephone Number

Player's Doctor - Name & Address

Player's Doctor - Telephone Number

Medical Information

Does the player suffer from asthma, chest complaint, wheezing or breathlessness, first or fainting, diabetes, or any other illness, disability or disorder?
YESNO

If 'YES', please provide details

Is the player allergic to anything you know of?
YESNO

If 'YES', please provide details

Is the player receiving any form of medical treatment at the moment?
YESNO

If 'YES', please provide details

Please notify a coach or manager if the answer to any of the above questions changes.

Consent

Parent/Carer Consent

I agree to the player in my care taking part in the activities of Bumble Bees RUFC. I understand that I will be kept informed of these activities e.g. timing of sessions and transport details. I have read and agree to abide by the parents / spectators Codes of Conduct. I understand that, in the event of injury or illness, all reasonable steps will be taken to contact me using the contact details provided, and to deal with that injury / illness appropriately. I hereby authorise any coach / first aider of Bumble Bees RUFC to sign on my behalf any papers required by the medical authorities in case of emergency medical treatments.
If you consent to the above please tick here:
I consent

I consent to the photographing/videoing and publication of images of the player in my care under the RFU’s guidelines. I confirm that I am legally entitled to give this consent and that the player is not under a Court Order.

If you consent to the above please tick here:
I consent

Player Consent

I have read and agree to abide by the Players Codes of Conduct.
If you consent to the above please tick here:
I consent

Today's Date:

Any provide any further information you think may be useful (optional):

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